What's So "Public" About the Public Option?

In a rhetorical gambit destined to sew confusion and frustration among supporters of health care reform, Democrats in the House seem poised to take the widely supported idea of health insurance "public option" and transform it into something that seems neither "public" nor, in the near future, "optional."

This shifting definition of "public option" came to light at a town hall meeting hosted by Yvette Clark (D-NY) in Crown Heights, Brooklyn, last night. During the meeting, Clark emphasized her emphatic support for a "robust public option," drawing standing ovations from the crowd. At other points in the town hall meeting, however, Clark's definition of what she meant by "public option" left the crowd confused and uneasy.

In her PowerPoint presentation, for example, Clark announced that a "public option" if passed would not be available until 2013. In response to this time line, many in the audience who had cheered Clark's declaration of support for a "public option" yelled out "What'll we do for four years?"and "Why so long?"

Even more peculiar than the long time line, when asked directly by an attendee "What is it exactly that will make the public option public?" Clark responded, "It will be public because it will be nonprofit." This answer elicited furled brows and silence from the room.

In other words, according to one of the most vocal advocates of a single-payer system--a Congresswoman deservedly lauded as a champion of health care reform--the "public option" did not mean a government administered program like Medicare, but a "nonprofit" entity established by a government grant, run independently, and not ready until after the next Presidential election--at least.

While it is impossible to know what most Americans imagine when they hear the phrase "public option" in the context of the health care reform debate, I can say for certain what I imagined and it was not a non-profit entity with a 4-year time line. What I imagined--or thought I imagined before last night's town hall--was a "public option" that would be unrolled similarly to Medicare.

Just after the signing of the Social Security Act of 1965 that created the program, President Lyndon Johnson held a second public ceremony to sign up the very first American for Medicare: Harry S. Truman.

In the videotape of the event, Johnson explains that Truman is getting preferential treatment by getting his card right away, because "the rest of the sign up cards would not go out until the end of the month." That is to say: one month after Medicare was signed into law, the Medicare enrollment cards arrived in mailboxes.

A time line similar to Johnson's Medicare roll out was pretty much what I had imagined whenever I heard members of Congress declare their support for "public option." I expected that a public option would become available for Americans within a few months of the law being signed. Apparently, I was wrong.

According to a recent article on Politico, the shifting definition of "public option" is not accidental, but is emerging from the perception by Democrats in the House that the August recess caused them great damage from which they need to come back:

The comeback for Democrats -- if there is one -- will begin in an all-important closed-door caucus meeting next week in the basement of the Capitol,
where House Speaker Nancy Pelosi (D-Calif.) and her top lieutenants will try to undo the damage of the August recess and convince their wobbly members that a vote for health care reform will not cost them their jobs in 2010.

Leaders say their strategy is to convince members that nothing is set in stone and that they are more than open to negotiations. And they're engaging in a softer sell, prioritizing health insurance reforms while pitching the public option as something that's way, way down the road. (link)

If the Politico account is accurate, the strategy of shifting the frame on the "public option" is bound to create more and more frustration among current supporters of a public option. The more Americans who understand that the Congress wants the public option to unfold slowly and in a not-very-public way, the more people will feel Democrats are betraying the principles of reform they claim to be supporting in their rhetoric.

Adding insult to injury, the fact that House Democrats plan to launch this strategy at a closed-door meeting has the potential to set in motion a perfect storm of suspicion among supporters of a truly public and ready-to-go "public option."

All of this means that the real debate to keep the "public" in a "public option," and to make it available sooner, rather than later, has not even begun. If that is the case, September could be a long month, indeed. And it is hard to see how Democrats will benefit if they shift the debate from demands for a "public option" to concerns as to whether the public option is still public and optional.